Yonsei Med J.  2023 Jul;64(7):413-422. 10.3349/ymj.2022.0649.

Impact of Atrial Fibrillation on Patients Undergoing Transcatheter Aortic Valve Implantation (TAVI): The K-TAVI Registry

• Lee SY
• Choi KH
• Park TK
• Kim J
• Kim EK
• Park SJ
• Park SW
• Gwon HC
• Chang K
• Yu CW
• Kim J
• Choi YJ
• Chae IH
• Lee JH
• Kim JH
• Park JS
• Kim WJ
• Yoon YW
• Ahn TH
• Lee SR
• Choi BJ
• Yang TH
• Choi CU
• Hur SH
• Oh SJ
• Lee HC
• Park H
• Kim HS
• Choi SH

• KMID: 2543900
• DOI: http://doi.org/10.3349/ymj.2022.0649

Abstract

Purpose
The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients.
Materials and Methods
A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year.
Results
AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001). Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%).
Conclusion
AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.

Keyword

Transcatheter aortic valve implantation; atrial fibrillation; Korean; antithrombotic agent